COMPLETE QUESTIONS WITH SOLUTIONS
GUARANTEED TO PASS
◉ A 4-year-old child with a history of the flu has a heart rate of 80
beats/minute, respirations of 16 breaths/minute, and capillary refill
of more than 3 seconds. The proper sequence for nursing
interventions would be:
A. Position the airway, administer 100% oxygen, obtain venous
access, and administer 20 ml/kg of an isotonic solution.
B. Administer 100% oxygen, obtain venous access, administer 0.
1 mg/kg of epinephrine 1:10,000, and prepare for endotracheal
intubation.
C. Position the airway, provide bag-mask ventilation, provide
synchronized cardioversion, and provide supplemental warmth.
D. Administer 100% oxygen, prepare for a venous cutdown,
administer 20 ml/kg of an isotonic solution, and obtain a chest x-ray.
Answer: A. Position the airway, administer 100% oxygen, obtain
venous access, and administer 20 ml/kg of an isotonic solution.
◉ A 3-year-old is transported by prehospital personnel after being
struck by a car. The parents are en route. The child is screaming and
uncooperative. Which is the best approach while conducting the
secondary survey?
,A. Hold the child to comfort him.
B. Wait for the parent's arrival.
C. Observe for behavioral pain cues.
D. Use a doll to demonstrate the examination. Answer: C. Observe for
behavioral pain cues.
◉ Which ocular finding is associated with child maltreatment?
A. Glaucoma.
B. Conjunctivitis.
C. Iritis.
D. Retinal hemorrhage. Answer: Retinal hemorrhage.
◉ A pregnant 18-year-old woman arrives at the emergency
department about ready to deliver a full-term infant. She states that
she noticed a large amount of dark green fluid the last time she went
to the bathroom. During the delivery, the nurse should prepare to:
A. Dry and arm the infant as soon as is it delivered.
B. Stimulate and ventilate the infant immediately after delivery.
C. Suction the mouth and nose of the infant while on the perineum.
D. Administer blow-by oxygen and rub the back immediately after
delivery. Answer: Suction the mouth and nose of the infant while on
the perineum
,◉ A 4-year-old presents with vomiting, lethargy, frequent urination,
weight loss, and dry mucous membranes. Vital signs reveal deep
respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR
of 144 beats per minute. Which of the following laboratory values
would be most expected in this child? Answer: Low pH level
◉ A teenager presents to the ED for evaluation of pain with deep
inspiration. The pain was a sudden onset after running track at
school. While obtaining the history, the patient states that they have
Marfan Syndrome. What would be a priority triage question based
on this information? Answer: "Have you ever had a pneumothorax?"
◉ A 6-week-old is brought to the emergency department by the
caregivers for poor feeding, listlessness, and fever. Assessment
reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute,
rectal temperature of 96.0 F (35.5 C), and a bulging anterior
fontanel. Capillary refill is 4 seconds. Based on these findings what is
the most likely diagnostic test the nurse should anticipate? Answer:
Lumbar puncture
◉ A 6-month-old arrives with swelling to the left thigh. Caregivers
deny any traumatic event. Assessment findings include a patient
who is active and alert, in the 10th percentile for length, and has
blue-grey sclera. Radiographs reveal a midshaft fracture of the left
femur. Which of the following is the most likely cause? Answer:
Osteogenesis imperfecta
, ◉ Which of the following is considered a "red flag" when triaging a
pediatric patient? Answer: A 3-week-old with a temperature of
38.2°C (100.7°F)
◉ A 4-year-old patient is being assessed for a foreign body in the
nose. The child is awake and alert and watching a video on the
caregivers phone. Vitals include HR of 110 beats/minute, RR of 26
breaths per minute, BP of 138/90 mm Hg, and T of 37.3oC (99.3oF)
orally. Which of the following interventions should the nurse
perform next? Answer: The normal systolic blood pressure for a 4
year old is between 89-112 mm Hg. The other vitals are within
normal limits for that age. When the clinical picture of the patient
does not match the vitals, check to make sure you are using the
correctly sized equipment first. A blood pressure cuff that is too
small will give a reading that is higher than it actually is.
◉ Parents with an infant requiring multiple laboratory tests,
radiographic studies, and invasive procedures appear to be
distressed and withdrawn. Which of the following interventions
would best ensure a sense of comfort and control for these parents?
Answer: Providing frequent updates and re-educating them on the
care that is being provided
◉ Caregivers state an 18-month-old child had a harsh, barky cough,
low-grade fever, and irritability throughout the night. On assessment
this morning, the child appears alert, is interactive, their present
cough is quiet, and their temperature is 98.8°F (37.1°C) axillary.